The Impact of Disease Severity and Symptoms on Anxiety and Depression in Individuals With Idiopathic Pulmonary Fibrosis

Zhe Wu; Karen Moor; Marlies Wijsenbeek; Christina Schlecker; Gerrit Weimann; Toby M Maher; Philip L Molyneaux

doi:10.1016/j.chest.2026.03.016

The Impact of Disease Severity and Symptoms on Anxiety and Depression in Individuals With Idiopathic Pulmonary Fibrosis

Chest. 2026 Mar 30:S0012-3692(26)00424-1. doi: 10.1016/j.chest.2026.03.016. Online ahead of print.

Authors

Zhe Wu¹, Karen Moor², Marlies Wijsenbeek², Christina Schlecker³, Gerrit Weimann³, Toby M Maher⁴, Philip L Molyneaux⁵

Affiliations

¹ National Heart and Lung Institute, Imperial College London, London, England.
² Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
³ Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany.
⁴ National Heart and Lung Institute, Imperial College London, London, England; Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, Los Angeles, CA.
⁵ National Heart and Lung Institute, Imperial College London, London, England. Electronic address: p.molyneaux@imperial.ac.uk.

PMID: 41921906
DOI: 10.1016/j.chest.2026.03.016

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is a debilitating, life-limiting fibrotic lung disease. Symptoms including breathlessness, cough, and fatigue, together with disease severity, contribute to psychological burden; however, the relationship between these factors and anxiety and depression remains unclear.

Research question: We investigated the prevalence and severity of anxiety and depression, and their association with symptoms and disease severity, in patients with IPF using the Hospital Anxiety and Depression Scale (HADS).

Study design and methods: This observational study prospectively recruited patients with incident IPF. HADS, Dyspnoea-12, Leicester Cough Questionnaire, cough visual analog scale, and lung function data were collected at baseline and 12 months.

Results: A total of 269 patients with IPF were recruited; 157 completed follow-up. The mean age was 73.5 years; 81% were male. Mean FVC % predicted ± SD was 79% ± 14.7%. At baseline, the prevalence of anxiety and depression (HADS score > 8) was 27.5% and 28.2%, respectively. On multivariate analysis, worse baseline Dyspnoea-12 and poorer living with idiopathic pulmonary fibrosis energy were independent factors for both anxiety and depression at baseline; younger age was a factor for anxiety. Baseline lung function did not correlate with either HADS anxiety or HADS depression. At follow-up, there was a numerical increase in HADS anxiety scores, which was below reported minimal clinically important difference values, and no notable change in HADS depression scores. Younger age, higher Dyspnoea-12 scores, and poorer living with idiopathic pulmonary fibrosis energy were associated with greater increases in anxiety. Moderate or weak correlations were observed between changes in HADS and longitudinal changes in patient-reported outcomes (worsening breathlessness, cough, and energy levels). Changes in FVC % predicted did not correlate with HADS.

Interpretation: Our results indicate that anxiety and depression are common in patients with IPF and are associated with more dyspnea and lower energy. The mental health burden experienced by patients with IPF needs better recognition and might be helped by targeted symptom management.

Keywords: anxiety; cough; depression; dyspnea; fatigue; idiopathic pulmonary fibrosis.